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5850 5980 University Avenue

Halifax, Canada
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Birnie K.A.,Dalhousie University | Birnie K.A.,5850 5980 University Avenue | Chambers C.T.,Dalhousie University | Chambers C.T.,5850 5980 University Avenue | And 4 more authors.
Journal of Pediatric Psychology | Year: 2017

Objective To explore relations between family functioning and child acute pain, including pain ratings, coping, and parent-child behaviors. Methods Community sample of 171 dyads including one child aged 8-12 years (52% girls) and one parent (79% mothers). Family functioning was assessed via child and parent self-report, and observation during a conflict discussion task. Children and parents rated pain catastrophizing at baseline, and child pain and distress following a cold pressor task (CPT). Parent-child interactions during the CPT were coded for observed behaviors during child pain. Results Self-report of poorer family functioning predicted greater child and parent pain catastrophizing, and parent distress. Less observed family negativity/conflict and cohesiveness, and greater family focus of problems and parent emotional support predicted more child symptom complaints. Family functioning was not associated with child pain or distress. Conclusions Family functioning influenced parent and child coping and child behavioral responses, but not the experience, of acute pain. © The Author 2016.

Flanagan H.E.,York University | Flanagan H.E.,5850 5980 University Avenue | Perry A.,York University | Freeman N.L.,Surrey Place Center
Research in Autism Spectrum Disorders | Year: 2012

File review data were used to explore the impact of a large-scale publicly funded Intensive Behavioral Intervention (IBI) program for young children with autism. Outcomes were compared for 61 children who received IBI and 61 individually matched children from a waitlist comparison group. In addition, predictors of better cognitive outcomes were explored (n = 142). Although random assignment did not take place, a standardized waitlist management system was used that did not include any prioritization other than time of referral. Groups did not differ significantly on available measures at intake. The treatment period tended to be longer than the waitlist period and this difference was controlled in analyses. At exit, the IBI group had better outcomes in all measured areas, with milder autism severity, higher adaptive functioning, and higher cognitive skills. Younger initial age predicted better cognitive outcomes in the IBI group but not the Waitlist group. Higher initial adaptive skills predicted better outcomes similarly in the two groups. Results support the effectiveness of community-based IBI and suggest that earlier age at treatment onset may increase the likelihood of better outcomes relative to comparison conditions. © 2011 Elsevier Ltd. All rights reserved.

George R.B.,5850 5980 University Avenue | McKeen D.,5850 5980 University Avenue | Chaplin A.C.,Dalhousie University | McLeod L.,Health Center
Canadian Journal of Anesthesia | Year: 2010

Introduction: Use of the lowest effective dose of oxytocin may reduce side effects. This study was designed to determine the effective dose (ED) 90 of oxytocin infusion for an elective Cesarean delivery (CD) to prevent uterine atony. Methods: The participants were ASA I and II, non-obese, non-labouring adult women undergoing an elective CD at term with a singleton gestation. The spinal anesthetic technique was standardized, and a blinded infusion of oxytocin was administered after delivery. The obstetrician rated the uterine contraction as either satisfactory or unsatisfactory. The initial dose of oxytocin infusion was 0.4 IU•min-1, and the dose for the next subject was based on the response of the preceding subject as per a biased-coin design up-down sequential method. The ED90 was calculated using Firth's penalized likelihood estimation. Results: Fifty subjects were screened, eight subjects were excluded, and two patients were withdrawn. Seven of the 40 subjects had uterine tone that was judged unsatisfactory by the obstetrician and required additional uterotonic medications. The ED90, i.e., the dose at which 90% of women were judged to have satisfactory uterine tone, was 0.29 IU•min-1 (95% confidence interval [CI] 0.15-0.43 IU•min-1). Discussion: In this study, we found the ED 90 of oxytocin required to prevent uterine atony and postpartum hemorrhage after an elective CD to be 0.29 IU•min-1- approximately 15 IU of oxytocin in 1 L of intravenous fluid administered over a one-hour period-(95% CI 0.15-0.43 IU•min-1). This oxytocin infusion dose is 30% less than the clinical infusions currently in use. It remains to be seen whether this dosing will be required for higher risk individuals or for labouring parturients undergoing non-elective CD. (Clinical Trial gov. NCT00785395). © 2010 Canadian Anesthesiologists' Society.

Bandstra N.F.,Dalhousie University | Bandstra N.F.,5850 5980 University Avenue | Chambers C.T.,Dalhousie University | Chambers C.T.,Health Center | And 3 more authors.
Pain | Year: 2011

Little is known about how children develop or express their empathy for another individual's pain. The current study compared the behavioural expression of empathy for pain with that for emotion, specifically sadness, in children. One hundred twenty children (60 boys, 60 girls) between the ages of 18 and 36 months (M = 26.44 months; SD = 5.17) were assessed for their empathy-related behavioural responses to simulations of an adult's pain and sadness, each presented separately. Children were more likely to be distressed by, but also more likely to be prosocially responsive to, another's sadness. Conversely, children were more likely to actively play during another's pain. Despite these differences, principal component analyses conducted separately for pain and sadness revealed conceptual similarities across simulation type. Components labelled as Empathic Concern and Personal Distress emerged for both simulations. Hierarchical regression analyses examining the influence of developmental (ie, age, sex) and interindividual (ie, temperament, social-emotional development, language abilities) variables of interest in children's empathy-related responses were conducted for each pain and sadness component. Age differences emerged only for pain. There were no sex differences for either simulation. Temperament showed some predictive value in how children would respond to sadness. Social-emotional variables showed some predictive value in how children would respond to pain and sadness. Language showed very little predictive value. These findings highlight both conceptual similarities across, and important differences between, children's expressions of empathy for pain and for sadness. Pain appears to be more easily ignored and results in fewer prosocial responses in children. Young children's reactions to simulations of adult pain and sadness were coded for empathy-related responses. Results indicated that children were less responsive to others' pain. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Hao W.,University of Western Ontario | Chorney J.M.,University of Western Ontario | Bezuhly M.,University of Western Ontario | Wilson K.,University of Western Ontario | Hong P.,5850 5980 University Avenue
Plastic and Reconstructive Surgery | Year: 2013

BACKGROUND:: There are limited data on the effect of otoplasty on health-related quality of life in children with prominent ears. Predictors of health-related quality-of-life outcomes in otoplasty have not been well studied. METHODS:: In this retrospective cohort study, 79 patients aged 18 years and younger who underwent otoplasty, and their parents, were asked to complete a survey, which included the Glasgow Children's Benefit Inventory and the Pediatric Quality of Life Inventory, to assess the parent-reported health-related quality-of-life changes and the current health-related quality of life, respectively. Other collected data included demographics, medical history, preoperative psychosocial experiences, motivations and expectations for surgery, postoperative complications, and general satisfaction. RESULTS:: Fifty patients (63 percent) replied. Of those, 88 percent reported being more satisfied with the appearance of their ears after otoplasty and 93 percent would choose to have this procedure again if given a second chance. The mean Glasgow Children's Benefit Inventory total score was 24.4 and the mean Pediatric Quality of Life Inventory total score was 94.3 for the Child Self-Report and 93.3 for the Parent Proxy-Report, indicating a positive health-related quality-of-life outcome. Linear regression analysis showed that history of teasing and expectations of a "life-changing" event were significant predictors of the Glasgow Children's Benefit Inventory total score (p < 0.01). CONCLUSIONS:: In this study, parents reported a significant improvement in their children's health-related quality of life following otoplasty. The children themselves also reported having a generally high health-related quality of life after surgery. Possible positive predictive factors to consider include preoperative psychosocial status and expectations.

Samuel N.,University of Toronto | Villani A.,University of Toronto | Fernandez C.V.,5850 5980 University Avenue | Malkin D.,University of Toronto
Nature Reviews Clinical Oncology | Year: 2014

The clinical management of familial cancer begins with recognition of patterns of cancer occurrence suggestive of genetic susceptibility in a proband or pedigree, to enable subsequent investigation of the underlying DNA mutations. In this regard, next-generation sequencing of DNA continues to transform cancer diagnostics, by enabling screening for cancer-susceptibility genes in the context of known and emerging familial cancer syndromes. Increasingly, not only are candidate cancer genes sequenced, but also entire 'healthy' genomes are mapped in children with cancer and their family members. Although large-scale genomic analysis is considered intrinsic to the success of cancer research and discovery, a number of accompanying ethical and technical issues must be addressed before this approach can be adopted widely in personalized therapy. In this Perspectives article, we describe our views on how the emergence of new sequencing technologies and cancer surveillance strategies is altering the framework for the clinical management of hereditary cancer. Genetic counselling and disclosure issues are discussed, and strategies for approaching ethical dilemmas are proposed. © 2014 Macmillan Publishers Limited. All rights reserved.

Phipps K.D.,Dalhousie University | Gebremeskel S.,Dalhousie University | Gillis J.,Dalhousie University | Hong P.,Dalhousie University | And 2 more authors.
Plastic and Reconstructive Surgery | Year: 2015

Background: Variability in graft retention with subsequent undercorrection remains a significant limitation of autologous fat grafting. The authors evaluated whether graft retention in a mouse model could be improved via graft supplementation with alternatively activated M2 macrophages, cells known to play a critical role in tissue repair. Methods: Grafts from C57BL/6 mouse inguinal fat pads were supplemented with M2 macrophages generated by intraperitoneal Brewer's thioglycollate injection and in vitro culture. Grafts with saline or M2 macrophages were injected under recipient mouse scalps and assessed by serial micro-computed tomographic analysis. Explanted grafts underwent immunohistochemical and flow cytometric analyses. M2 culture supernatants were added to stromal vascular fraction adipose-derived stem cells to assess adipogenic gene expression induction. Results: One month after graft injection, no significant difference was noted between M2 macrophage-supplemented (105 7.0 mm3) and control graft volumes (72 22 mm3). By 3 months after injection, M2 macrophage-supplemented grafts remained stable, whereas controls experienced further volume loss (103 8 mm3 versus 39.4 15 mm3; p = 0.015). Presence of macrophages in supplemented grafts was confirmed by flow cytometry. M2 macrophage- supplemented grafts exhibited a 157 percent increase in vascular density compared with controls (p < 0.05). Induction of adipogenic C/EBPα gene expression was observed with M2 supernatants addition to stromal vascular fraction adipose-derived stem cells. Conclusions: M2 macrophages improve autologous fat graft volume retention by stimulating angiogenesis. These findings provide proof-of-principle for development of fat grafting techniques that harness reparative properties of M2 macrophages. Copyright © 2014 by the American Society of Plastic Surgeons.

Veinotte C.J.,5850 5980 University Avenue | Veinotte C.J.,Dalhousie University | Dellaire G.,Dalhousie University | Berman J.N.,5850 5980 University Avenue | Berman J.N.,Dalhousie University
DMM Disease Models and Mechanisms | Year: 2014

The current preclinical pipeline for drug discovery can be cumbersome and costly, which limits the number of compounds that can effectively be transitioned to use as therapies. Chemical screens in zebrafish have uncovered new uses for existing drugs and identified promising new compounds from large libraries. Xenotransplantation of human cancer cells into zebrafish embryos builds on this work and enables direct evaluation of patient-derived tumor specimens in vivo in a rapid and cost-effective manner. The short time frame needed for xenotransplantation studies means that the zebrafish can serve as an early preclinical drug screening tool and can also help personalize cancer therapy by providing real-time data on the response of the human cells to treatment. In this Review, we summarize the use of zebrafish embryos in drug screening and highlight the potential for xenotransplantation approaches to be adopted as a preclinical tool to identify and prioritize therapies for further clinical evaluation. We also discuss some of the limitations of using zebrafish xenografts and the benefits of using them in concert with murine xenografts in drug optimization. © 2014. Published by The Company of Biologists Ltd.

Bernstein M.L.,5850 5980 University Avenue | Bernstein M.L.,Dalhousie University
Cancer | Year: 2011

Cancers in children and adolescents are fortunately infrequent. Overall, cure rates are good, approximately 80%, although this varies by histology and stage. Targeted therapies aim to improve efficacy and decrease toxicity by more specifically affecting malignant cells or their supporting stroma. Cancers of early life are often of different histology than those seen in adults. Sometimes, the same pathway is affected, even if the histology is different. Toxicities may also be different, particularly in younger children. These factors render drug development in young people challenging. This article reviews some successes and challenges to that development, including brief discussions of imatinib, lestaurtinib, antiangiogenesis, and anti-GD2 therapies. Copyright © 2011 American Cancer Society.

The survival outcome of childhood cancers in developing nations has failed to keep pace with that of developed nations. Technological advances offer a unique and radical opportunity to develop programs and strategies to improve outcomes of childhood cancer globally. The novel field of 'techno-oncology' has a broad scope and the potential to phenomenally impact, revamp and model the care of pediatric cancer patients in the developing world. Many frontiers and opportunities in the area remain to be explored as well as many challenges to be surmounted. © 2015 Informa UK, Ltd.

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